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Old 06-28-2022, 10:31 AM   #1
Michael Thayne
 
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Default How deadly should infected wounds be, on average?

B444 says that a "typical" infected wound requires daily HT rolls, with failure costing 1 HP and success halting the infection. I wonder if this is too generous—most of the time you'll only take 1 or 2 points of damage before succeeding on that HT roll, and while the damage from infection might be enough to force an additional death check from a bad injury, there's basically no risk here of a relatively minor injury developing into something that kills you. In contrast, the bleeding rules require three successful HT rolls rolls, consecutively, such that if you succeed, then fail, then succeed, then fail, then succeed, you're still bleeding. Plus, there's a penalty to the HT roll for especially big wounds.

My question is: what's the best way to give "generic infection" some real teeth? Replacing the HT roll with an HT-3 roll would make infection very roughly as dangerous as bleeding. But I don't have a good sense either of what's realistic, or what makes for good gameplay. It seems to me that good gameplay demands that if you're bothering to use the rule at all, the danger should be serious enough to make players care about infection, and worry about getting wounded comrades proper medical care, even if most of the time it turns out to be a minor annoyance. But good gameplay might also demand somewhat less deadly rules than are strictly realistic. Thoughts?
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Old 06-28-2022, 10:43 AM   #2
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Default Re: How deadly should infected wounds be, on average?

Very few players actually want realism, but if I was trying for something more realistic infection should vary with the size of the original wound.
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Old 06-28-2022, 11:12 AM   #3
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Default Re: How deadly should infected wounds be, on average?

Quote:
Originally Posted by Michael Thayne View Post
B444 says that a "typical" infected wound requires daily HT rolls, with failure costing 1 HP and success halting the infection. I wonder if this is too generous—most of the time you'll only take 1 or 2 points of damage before succeeding on that HT roll, and while the damage from infection might be enough to force an additional death check from a bad injury, there's basically no risk here of a relatively minor injury developing into something that kills you.

My question is: what's the best way to give "generic infection" some real teeth? Replacing the HT roll with an HT-3 roll would make infection very roughly as dangerous as bleeding.
Zombies 56 has a perk called "Pestilant Wounds" you can take for zombies which changes the HT+3 roll to an HT+0 roll due to a -3 penalty, equivalent to "Locale harbors a special infection" from B444, which applies to any biting they do, plus if they have thrust-cutting damage from "Claws" (ie no skin on the fingertips) perk.

It also applies to ANY attack doing 1 HP plus (ie even if the zombie lacks Claws, or wants to kick or slam you) if you have an open wound already.

I do like the idea of there being an HT penalty based on the severity of the wound. IE if it bleeds more it should get more easily infected.

IMO the B420 rules of -1 to HT roll per 5 HP lost should be changed to 'per 50% lost' so it scales with different HP levels. Then we could apply the same system to infection penalties.
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Old 06-28-2022, 11:41 AM   #4
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Default Re: How deadly should infected wounds be, on average?

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Originally Posted by Anthony View Post
Very few players actually want realism, but if I was trying for something more realistic infection should vary with the size of the original wound.
Sure, but if "infection" rarely amounts to anything beyond an extra point or two of damage, the rules aren't worth the trouble of the extra die rolls. And nasty infected wounds can be appropriate for genres like survival horror.
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Old 06-28-2022, 11:46 AM   #5
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Default Re: How deadly should infected wounds be, on average?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1281639/ says that at London hospitals in the 1850s, the survival rate for surgical amputations was around 60%. That's a bad case for surviving an infection: non-sterile operating and recovery environments, no anti-biotics, but some attempts at post-operation care. Though I'm not really sure how much difference the care made.

When I flipped my bicycle and broke everything, my shoulder wound got infected despite thorough attention by the trauma docs[1]. Even so, that was treated more as annoying and gross instead of life-threatening, and it actually took a follow-up visit or two to get anti-biotics prescribed. On the other hand, it did not go away on its own at all.

If you're looking for a harsh realism game, infected wounds should probably do 1 HP/day, resisted at some HT penalty sufficient to kill about 40% of the HT 10 population - I don't know what that number is. Possibly with some symptoms that include additional HT penalties, so the people who fight the infection off early are okay, but there's a rapid down spiral if the infection isn't resisted early on. It'd probably make the math easier.

[1] The rules on B444 for catching an infection seem too generous, based on my limited experience. I only had 1-2 open wounds, was hospitalized, and still got an infection. Maybe my surgeon critically failed the Physician roll, but I'd say for harsh realism games, people need to roll to resist infection even at TL 6+.

On the other hand, given some of the other oddities of my medical history, maybe I just have Unlucky (Medical issues only) [-1] and the infection was just a result of that.
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Old 06-28-2022, 11:47 AM   #6
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Default Re: How deadly should infected wounds be, on average?

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Originally Posted by Michael Thayne View Post
Sure, but if "infection" rarely amounts to anything beyond an extra point or two of damage, the rules aren't worth the trouble of the extra die rolls. And nasty infected wounds can be appropriate for genres like survival horror.
Sure, I suspect more severe rules that get ignored by default should be the base.
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Old 06-28-2022, 12:08 PM   #7
Michael Thayne
 
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Default Re: How deadly should infected wounds be, on average?

Quote:
Originally Posted by mlangsdorf View Post
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1281639/ says that at London hospitals in the 1850s, the survival rate for surgical amputations was around 60%. That's a bad case for surviving an infection: non-sterile operating and recovery environments, no anti-biotics, but some attempts at post-operation care. Though I'm not really sure how much difference the care made.

When I flipped my bicycle and broke everything, my shoulder wound got infected despite thorough attention by the trauma docs[1]. Even so, that was treated more as annoying and gross instead of life-threatening, and it actually took a follow-up visit or two to get anti-biotics prescribed. On the other hand, it did not go away on its own at all.

If you're looking for a harsh realism game, infected wounds should probably do 1 HP/day, resisted at some HT penalty sufficient to kill about 40% of the HT 10 population - I don't know what that number is. Possibly with some symptoms that include additional HT penalties, so the people who fight the infection off early are okay, but there's a rapid down spiral if the infection isn't resisted early on. It'd probably make the math easier.

[1] The rules on B444 for catching an infection seem too generous, based on my limited experience. I only had 1-2 open wounds, was hospitalized, and still got an infection. Maybe my surgeon critically failed the Physician roll, but I'd say for harsh realism games, people need to roll to resist infection even at TL 6+.

On the other hand, given some of the other oddities of my medical history, maybe I just have Unlucky (Medical issues only) [-1] and the infection was just a result of that.
I've had a fair number of minor cuts and scrapes get a bit inflamed, but rarely badly enough to worry about seeing a doctor for. And sure I used Neosporin, but rather inconsistently and I kind of doubt it made that much of a difference. When I have gone to the doctor for relatively minor injuries, the thing they always want to know is if my tetanus shots are up to date. Which makes me wonder what percentage of historical cases of "died from a seemingly minor wound received in a battle, duel, etc." were literally just tetanus.
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Old 06-28-2022, 12:43 PM   #8
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Default Re: How deadly should infected wounds be, on average?

Off the top of my head, I'd say test out something like the following (this is sorta the "full fat" version - feel free to pick and choose depending on the level of detail you want). This would be combined with existing rules for things like medical care, environment, etc.

Wound Size (note in all cases, if the GM decides it doesn't break the skin - such as for a smooth bludgeon - there's no chance of infection)
Scratch: Anything below HP/10 (note this includes No Wounding carrier attacks for Blood Agents); roll against HT+2
Minor: Anything up to HP/5; roll against HT
Moderate: Anything up to HP/2; roll against HT-2
Major: Anything up to 1xHP; roll against HT-4
Severe: Anything up to 2xHP; roll against HT-6
Critical: Anything up to 5xHP; roll against HT-8
(if you like, you can instead state every +1 SSR to wounding is -1 to HT - +1 up to HP/7, -1 up to HP/3, etc)
(EDIT: Burning and Corrosion damage may be appropriate to treat as though they caused twice as much wounding as what was rolled for purposes of infection, due to the fact they tend to affect a large surface area)

Initial Infection
Your initial roll to resist the infection dictates how serious it is (how much "pathogen load" you initially were exposed to, what sort of pathogen it was, etc). This rule would be rather simple - record your MoF on the attempt to initially avoid infection - this (or half this, to be a bit less harsh) is the penalty you take on later attempts to avoid taking damage and/or shake off the disease. Optionally, when using this, success doesn't mean you avoid the infection entirely unless you have MoS 5+ - rather, you get a bonus on later attempts to avoid taking damage and/or shake off the disease equal to MoS.

Multiple Successes to Recover
Like bleeding, infection requires you to succeed three times in a row to actually end the effect. Alternatively, you could mash this together with Initial Infection, above, for a bit of a roller-coaster. For this alternate option, Initial Infection is handled as normal. When you make a recovery roll, on a Failure you suffer 1 HP Injury and your penalty changes to the worse of your new MoF and the initial penalty. On a Success, you suffer no Injury and the penalty is offset by an amount equal to MoS. Once the penalty reaches +0 (or a +5 bonus, if using the option that you need MoS 5 to avoid the infection entirely), the disease ends.
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Old 06-28-2022, 01:04 PM   #9
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Default Re: How deadly should infected wounds be, on average?

It really will depend on the type and size of the wound, location also factors in. The environment and treatment also are huge.
I'd say infection effects are more likely to be a slow loss of HP that if untreated could result in crippling injury. An infected wound is going to be more sensitive and so irritating, through agony conditions should apply at certain threshold levels.
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Old 06-28-2022, 01:04 PM   #10
Michael Thayne
 
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Default Re: How deadly should infected wounds be, on average?

One option would be to literally copy the bleeding rules, just with longer intervals between rolls and different treatments to help the patient recover. That would make infection exactly as deadly as bleeding when untreated, but frequently more deadly than bleeding if you only receive low tech (or maybe even TL5) treatment for the wound. That might not be the "best" solution, but good enough for government work. In fact, I wonder—did the 3e rules for "generic" infection only require one success to recover? I know other diseases required multiple successes, that seems less common in 4e, perhaps due to a desire to impose some consistency on the disease rules?
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